Advances in battlefield medicine unmatched by care at home

Advances in battlefield medicine unmatched by care at home

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COLORADO SPRINGS, Colo., May 28, 2014—Advances in battlefield medicine have greatly reduced fatalities among U.S. troops engaged in the war on terror in Afghanistan and Iraq. Many severely wounded soldiers who would have died in previous wars now return home. What awaits them here? The story is not universally good.

During the Civil War, battlefield medicine was crude. An estimated 30,000 amputations were performed, according to Jan Herman, senior historian of the Navy Medical Department. If the injured limb were not removed, the patient would die as a result of infection or gangrene.

Before helicopter evacuation of the wounded in Vietnam, many patients bled to death in ambulances on the road to field hospitals. Double and especially triple amputees, “in earlier wars, would have hemorrhaged to death. They would not have been able to stop the bleeding.”

Thanks to improvements ranging from high-tech, fast-clotting bandages to low-tech tourniquets, the capabilities of field medics “have really undergone a revolution in the last few years,” says Col. John Holcomb, head of the Army’s Institute of Surgical Research in San Antonio.

We are better at stopping the bleeding; we transport the wounded to field hospitals much faster. In World Wars I and II, there were about 1.7 service members wounded for every one killed. In Iraq and Afghanistan, it is about seven to one.

Yet while these kinds of injuries have proved less fatal, there are other injuries less physical but no less damaging: Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injuries (TBI), characteristic of these wars. Often these effects are unseen and untreated and the veteran returns home with little treatment and few options.

The Equal Justice Foundation in Colorado Springs, Colorado, advocates for veterans who, largely as a result of their injuries, have run afoul of the law. The EJF performed a study in 2011 of some 3200 veterans and active-duty military who were arrested and booked into the county Criminal Justice Center that year.

They found that veterans are being treated like criminals instead of people with psychological or physical injuries.

A criminal conviction often makes it impossible for veterans to obtain employment and frequently devastates families and children. The injuries are plainly a factor in increased rates of homelessness, suicide, and homicide among veterans.

Another startling find of the EJF study is that while arrests of civilians tapers off sharply after age 30, arrests of veterans continues steadily regardless of age. Virtually all the inmates in the Criminal Justice Center over 50 are veterans and so the county jail effectively becomes an Old Soldiers Home. Available data make it evident that veterans who remain in El Paso County after their first arrest will keep getting arrested over and over again.

These veterans are bringing back a psychological plague that is not being properly or fully diagnosed, that is not being addressed at the critical time to prevent more harm and violence, and is spreading to family and friends. Evidence in the EJF report makes it clear that the epidemic today will echo down the decades until at least mid-century. The repercussions are magnified by Iraq and Afghanistan veterans who have endured multiple combat tours and survived injuries that would have been fatal in previous conflicts.

Advances in battlefield medicine need to be matched by treatment of all types of injuries, psychological as well as physical, once a soldier returns home. We owe our veterans nothing less.

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